Kuo T-F, Lee M-R, Huang H-L, Chen K-C, Lin M-W, Kuo S-W, Huang P-M, Chen H-H, Wang J-Y, Chen J-S
Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C).
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan (R.O.C).
IJTLD Open. 2025 Jul 9;2(7):412-419. doi: 10.5588/ijtldopen.25.0127. eCollection 2025 Jul.
Adjuvant lung resection surgery benefits selected patients with nontuberculous mycobacterial pulmonary disease (NTM-PD); however, optimal timing remains controversial. This study evaluated surgical outcomes and prognostic factors, with a focus on the timing of surgical intervention.
This study included 41 patients with NTM-PD who underwent adjuvant lung resection surgery between January 2000 and August 2022. Data on patient characteristics, surgical procedures and postoperative outcomes were analyzed. The primary outcome, defined as freedom from unfavorable outcomes (mortality, failure to achieve sputum culture conversion, or microbiological recurrence), was estimated using the Kaplan-Meier method, with prognostic factors analyzed by Cox regression model.
Extensive disease was observed in 35 (85%) patients. The median preoperative antibiotic duration was 3.2 months. Twenty-two (54%) patients received lobectomies, whereas 15 (37%) received wedge resections. Thirty-four (83%) achieved sputum culture conversion. The probability of being free from unfavorable outcomes within two years was 80%. Independent favorable prognostic factors included body mass index ≥ 18.5 kg/m (=0.007) and early surgical intervention (preoperative antibiotic duration < 3 months, =0.039). Additionally, early surgical intervention correlated with shorter operation time (=0.03).
Early surgical intervention, irrespective of the surgical approach, appeared feasible and potentially beneficial even in patients with extensive NTM-PD.
辅助性肺切除术对部分非结核分枝杆菌肺病（NTM-PD）患者有益；然而，最佳手术时机仍存在争议。本研究评估了手术结果和预后因素，重点关注手术干预的时机。
本研究纳入了2000年1月至2022年8月期间接受辅助性肺切除术的41例NTM-PD患者。分析了患者特征、手术方式和术后结果的数据。主要结局定义为无不良结局（死亡、痰培养未转阴或微生物学复发），采用Kaplan-Meier法进行估计，通过Cox回归模型分析预后因素。
35例（85%）患者存在广泛病变。术前抗生素使用的中位时长为3.2个月。22例（54%）患者接受了肺叶切除术，而15例（37%）接受了楔形切除术。34例（83%）患者痰培养转阴。两年内无不良结局的概率为80%。独立的有利预后因素包括体重指数≥18.5kg/m（=0.007）和早期手术干预（术前抗生素使用时长<3个月，=0.039）。此外，早期手术干预与较短的手术时间相关（=0.03）。
即使对于广泛NTM-PD患者，早期手术干预，无论手术方式如何，似乎都是可行的且可能有益。
